title: Tobacco, alcohol, and drug use among hospital patients: concurrent use and willingness to change.
abstract: BACKGROUND
  Data are limited on concurrent smoking and substance use among hospital patients. To better inform hospital-based intervention strategies, we evaluated the prevalence and concurrent use of these behaviors. This study evaluated the association between tobacco, alcohol, and other drug use, compared willingness to quit smoking among patients with and without substance use, and evaluated the relationship between willingness to quit smoking and readiness to change substance use.
  
  
  METHODS
  This study was a cross-sectional survey of non-Intensive Care Unit hospital patients at 2 public hospitals (a 464-bed tertiary-care hospital and a 100-bed community hospital) by bedside interview. Severity of use and willingness to change behavior was determined. We evaluated the association between smoking and substance use by multivariable methods.
  
  
  RESULTS
  Of 7,391 patients with known smoking status, 2,684 (36%) were current smokers. Among them, 1,376 hospitalized smokers (51%) had concurrent substance use. Among the 1,972 patients with at-risk alcohol or drug use, the prevalence of smoking was 70% compared to 24% for non-substance users (P < .01). Compared to other patients who smoked, substance-dependent patients were more likely (Prevalence Rate Ratio = 1.4, 95% Confidence Interval = 1.1-1.9) to be moderate to heavy smokers. Regardless of substance use pattern, most patients (60%) expressed a desire to immediately quit smoking.
  
  
  CONCLUSIONS
  Hospital patients who describe at-risk substance use are likely to smoke and express willingness to quit smoking. Given the prevalence of concurrent smoking and substance use and patients' desire to change both behaviors, there is a need for coordination of substance use and smoking cessation interventions.
authors.affiliation: Department of Medicine, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, USA. akatz@nmff.org
authors.forename: Ariel
authors.initials: A
authors.lastname: Katz
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
authors.forename: Jennifer
authors.initials: J
authors.lastname: Smith
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D033182:Intention; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000453:epidemiology*